What is EMDR and How Can it Help?

Eye Movement Desensitization & Reprocessing (EMDR) therapy is a well-researched psychotherapy method that is proven to help people recover from trauma and other negative life experiences.

EMDR works exceedingly well to resolve unprocessed traumatic events and offers lasting results in fewer sessions than other psychotherapy treatments. It works by allowing the brain to release the fight, flight, freeze instinct surrounding traumatic events so that the negative emotions can move into long-term storage alongside other non-traumatic experiences where they belong.

We use EMDR therapy for depression, anxiety, panic disorder, phobias, bipolar and dissociative disorders, eating disorders, grief and loss, PTSD, child abuse, physical and sexual abuse, substance abuse, addiction and even chronic illness and medical issues. The connection between all of these conditions seems to be unprocessed negative emotions that become “stuck” in the mind due to their overwhelming nature, unable to be processed like our normal, everyday experiences.

One of the most remarkable qualities of EMDR therapy for anxiety and other issues is that it does not require a person to talk extensively about their experiences. There is no homework to complete between sessions and no complicated protocols to learn. It does not focus on changing thoughts, feelings or beliefs, but rather on allowing the brain’s innate healing process to take over and release negative emotions in a natural and effective way.

“Changing the memories that form the way we see ourselves also changes the way we view others. Therefore, our relationships, job performance, what we are willing to do or are able to resist, all move in a positive direction.” – Francine Shapiro, Ph.D.

The Theory of EMDR

Dr. Francine Shapiro discovered EMDR in 1987 while walking in a park when she noticed that by moving her eyes rapidly back and forth while focusing on negative thoughts she could cause the disturbance to subside. At the time, she was a graduate student studying psychology and so she decided to research what was happening more closely. Out of her studies and test protocol emerged the therapy that we now know of as Eye Movement Desensitization and Reprocessing.

But how does EMDR actually work in the brain? We need to go into a bit more detail about the structure of the brain to fully understand what is happening. Let's look at the specific portions of the brain that are involved in EMDR:

• Amygdala: The watchtower, it signals the alarm at the threat of danger or stressful events. During an EMDR treatment, a client is asked to focus on a traumatic memory before going through various sets of side-to-side eye movements, sounds or tapping. It has been scientifically proven that side-to-side eye movements deactivate the amygdala, effectively reducing the fear response that emerges when we focus on traumatic memories. This would explain why EMDR therapy for anxiety and other fear-based conditions has proven to be so effective.

• Hippocampus: Involved in new learning formation, consolidation of information from short-term memory to encoding and retrieval of long-term memories, as well as helping us to understand safety and danger. Trauma can actually reduce the volume of the hippocampus, compromising its function. EMDR has been scientifically proven to not only improve the negative symptoms associated with trauma but to increase the volume of the hippocampus, helping to restore its function. Major depressive disorder has been linked to volume reduction of the hippocampus, providing an explanation for the positive results obtained when using EMDR therapy for depression. 

• Prefrontal Cortex: Analyzes and controls behavior and emotions. This study shows that the effectiveness of EMDR may be associated with the reduction of prefrontal cortex over-activation during trauma-related recall as well as an increase in grey matter volume and improved function. This may explain why EMDR therapy for children can help them to better regulate their emotions and boost confidence and self-esteem.

It is remarkable that such a simple protocol of recalling a trauma and performing side-to-side eye movements can trigger such a powerful healing cascade within the deep structures of the brain. Often the simplest protocols are the most effective, especially those that resemble patterns found elsewhere in the body's natural healing and maintenance processes.

Since the early days, Dr. Shapiro has argued that the effectiveness of bilateral eye movements is related to brain processes similar to those initiated by Rapid Eye Movement (REM) sleep. It has been proposed that the repeated redirection of attention caused by the side-to-side eye movements causes traumatic and emotionally charged memories to become more ordinary and less emotionally overwhelming. The result is a reduction in the power of the memory, as mediated by the hippocampus, and a reduction in the associated negative emotions, as mediated by the amygdala.

What To Expect

EMDR in Practice

The basic premise of EMDR is simple, although in practice your therapist will follow a detailed protocol to guide you through the process of reducing and eliminating negative emotions associated with your traumatic memories before transitioning into the identification of positive cognitions, i.e. going from a fear of flying to solidifying your belief that flying is a very safe form of travel. In this way, you are moving through your past memories, the present disturbances related to them and developing positive ideas about the future.

It is important to note that "processing" of experiences does not necessarily mean talking about them. "Processing" means creating a particular state that allows traumatic experiences to be fully "digested" and stored appropriately in the brain. Useful information from your experiences is learned and negative reactions are released. The protocol remains largely the same whether we are using EMDR therapy for anxiety, depression, PTSD or any other symptoms.

Below is a summary of the eight distinct phases of EMDR treatment:

• Phase 1 - History and Treatment Planning: The first phase of treatment involves taking a detailed history of your life experiences to develop a comprehensive treatment plan. There will be discussion about the specific problems that brought you into therapy and the negative feelings and behaviors that are associated with them. Again, this does not mean that you need to share many details about your past trauma, but just about how it is affecting your current ability to lead a happy and healthy life. The treatment plan will include the events from the past that created the problem, the present situations that are causing distress and the skills and behaviors that you must learn in order to positively move forward in your life.

• Phase 2 - Preparation: In this phase, your therapist will explain the theory of EMDR, how it is done and what to expect during and after treatment. Your therapist will teach you specific techniques to deal with overwhelming emotions that may arise during a session. These include things like the “safe place” exercise, which can enable you to feel more grounded in a safe and peaceful environment. Another technique is to imagine a “secure attachment” relationship with a trusted mentor or caretaker that can allow you to experience love, acceptance and approval (even if this person did not exist in your own life). Other techniques may include focusing on emotional coping skills that can be used during and after the retreat.

• Phase 3 - Assessment: In this phase, your therapist will help you create a chronological “worst things list” of the major adverse memories in your history, including rating each memory based on the Subject Units of Disturbance scale, or SUD, from 0 to 10. The goal of trauma processing is to reduce the SUD of your traumatic memories down to or as close to 0 as possible. Each memory will be reviewed and a negative self-belief will be identified that is associated with the event. Essentially, these negative beliefs are representations of the disturbing emotions that still surround the traumatic event.

The next step is to pick a positive self-belief that you would rather believe, i.e. "I am worthy of love". For the survivor of a natural disaster, a negative cognition may be "I am in danger", and the related positive cognition can be "I am safe now". The feeling of danger locked in the nervous system is no longer relevant, as the danger is in the past. The positive cognition should reflect what is currently true in the present. Your therapist will ask you to rate your positive belief on a Validity of Cognition (VOC) scale from 1 (completely false) to 7 (completely true). Our goal is to reduce the SUD of your negative memory as close to 0 and increase the VOC of the positive cognition as close to 7 as possible.

An example of a course of treatment would be using EMDR therapy for depression related to your punishment as a child. EMDR can help you process the painful memories of your punishment, release the negative self-belief that you are unlovable and install and strengthen a new belief that you are worthy of love.

• Phase 4 - Desensitization: This phase focuses on reducing the intensity of the disturbing emotions related to your negative past experiences. During desensitization, your therapist will lead you through sets of side-to-side eye movements, sounds or tapping. Sets last approximately 30-60 seconds, after which you will be asked to briefly discuss what came up before going into the next set. The goal of desensitization is to follow your thoughts and allow the SUD of the negative memories to reduce until complete resolution is achieved. Often this can happen in only a few sessions. The advantage of our intensive therapy retreats is that much more progress can be made in a short period of time, as there is space for significantly more processing within the course of a full day compared to single 60-90 min weekly sessions.

• Phase 5 - Installation: During desensitization, you have worked to reduce the negative emotions and cognitions related to a traumatic event. The goal of installation is to increase the strength of the positive belief that you have identified to replace your original negative belief. The positive belief is "installed" using a similar side-to-side eye movement, sound or tapping technique as desensitization. The goal is to increase the VOC scale as close to 7 as possible. It is important to note that if you truly need to do some outside work to reach a 7, such as begin self-defense training to feel safe against the possibility of an attack, then this will be reflected in the maximum VOC that you can achieve. Only once you take the necessary steps in your everyday life will your VOC for this particular positive belief reach a 7.    

• Phase 6 - Body Scan: After the positive cognition has been strengthened and installed, your therapist will ask you to bring the original traumatic event to mind to see if there is any residual tension held in your body. If so, the physical sensations will be targeted for reprocessing using a similar desensitization technique. This step is absolutely crucial, as it has been well established that the body also stores information about traumatic events. Whereas the mind holds narrative memories, the body retains what are called motoric memories, containing information about specific posturing and holding patterns that are connected to the trauma. EMDR treatment is not considered successful until there are also no physical sensations related to the traumatic memory. The positive beliefs must be integrated on both a psychological and physiological level.

• Phase 7 - Closure: If the processing of the traumatic event is not complete before the end of a session, your therapist will guide you through the self-calming techniques learned in Phase 2 to reestablish a sense of balance before heading back into the outside world. You will also receive a briefing on what to expect in between sessions, as some processing may continue after the fact and new material may arise. It is important that you feel confident in your ability to self-soothe so that these experiences can be dealt with effectively.

• Phase 8 - Reevaluation: At the start of each day, your therapist will revisit your worst things list and reevaluate the SUD of each negative memory to ensure that progress is being made. It can be quite inspiring to see that as more and more processing is done, your negative experiences will continue to register a lower and lower SUD. An interesting phenomenon when working chronologically from earliest to most recent negative memories is that processing of our earliest trauma can often reduce the SUD of more recent memories as well.

So much of the distress related to our most recent negative experiences has to do with our earliest traumas and the negative beliefs associated with them. When these are released, we can often recognize that more recent traumas are actually not a serious as we thought they were. This is another reason why EMDR therapy for children is so beneficial. Years of suffering can be avoided by helping children process early trauma, allowing them to more freely develop into well-adjusted young adults.       

What To Expect